Permit CITY OF TIGARD SEWER CONNECTION PERMIT
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• * _. - COMMUNITY DEVELOPMENT Permit #: SWR2012 -00004
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/10/2012
Parcel: 2S102AD01900
Jurisdiction: Tigard
Site address: 8935 SW BURNHAM ST
Project: TVF &R Subdivision: TIGARD HIGHWAY TRACTS Lot: 21
Project Description: .375 EDU increase
Contractor: Owner: TUALATIN VALLEY FIRE & RESCUE
20665 SW BLANTON ST
ALOHA, OR 97007
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection 01/10/2012 $1,687.50
Type of Use: COM
Class of Work: ALT
Install Type:
Fixture Units:
Number of Dwelling Units: .375
Total $1,687.50
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable
law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if
work i •spen•e• - more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification
Ce er. Those rules are -et forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions
to •UNC by call g 503.232.19: • .:00 - .2344.
ssued By: / / /a L///AALA / Permittee Signature: 1":"<"'-(t / -Z
1
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
UPI
0 t Tenant Name: Tualatin Valley Fir &Rescue ccumulative Sewer Tally SWR # 2012 - 00004
rTUGARi Site Address: 8935 SW Burnham St PLM # 2012 -00004
Parcel #: 2S102AD01900
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #s value count added # added value total #s total values
Baptisery/Font 4 0 0 0 0 0
Bath: - Tub /Shower 4 0 0 0 0 0
- Jacuzzi /Whirlpool 4 0 0 0 0 0
Car Wash: - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor /Water Aspirator 1 0 0 0 0 0
Dishwasher: - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink: - 2 inch 2 0 0 0 0 0
- 3 inch 5 0 0 0 0 ' 0
- 4 inch 6 0 0 0 0 0
- Car Wash 6 0 0 0 0 0
Garbage Disposal:
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- Commercial (to 5 I -IP) 32 0 0 0 0 0
- Industrial (over 5 I -IP) 42 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower: - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 0 0 0
Sink:
- Lay/Bar - Non -Food Related 2 0 0 0 0 0
- Bradley 5 0 0 0 0 0
- Com /Serv/Util - Food Related 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 1 6 1 6
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 1 6 1 6
Current Fixture Value 6 divided by 16 = 0.4 Current EDU 1 EDU = $4,500.00
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 6 divided by 16 = 0.4 over (under) $ 1,687.50
Enter EDU Change Here 0.375
Notes: Per Mark V, calculations to be done at S281.25 per fixture unit.
Authorized Name /Signature: Debbie Adamski Date: 1/10/2012
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I:\ Building \ Sewer Tally \Sewerl'allySheet- 4500.xls 07/01 /11